Ebola Requires a Team Africa

It'll take more than a village.

There's a reason Ebola generates more terror than most viral illnesses: Doctors have no cure, and as many as 9 in 10 of its victims die. The only silver lining is that outbreaks have always been readily contained.

Sadly, the new epidemic in Africa is another story. It has killed more than 650 people in Guinea, Liberia and Sierra Leone, and shows no sign of abating. Last week, Sierra Leone's top Ebola doctor became infected with the virus, and the first case was reported in Lagos, the continent's biggest city.

Doctors Without Borders has declared this outbreak to be "out of control." It should know. The group, working in conjunction with local health authorities, is a principal provider of Ebola care.

Until now, health professionals have stopped Ebola's spread by isolating the sick, caring for them using protective gear, monitoring contact, and educating communities on the way the disease spreads (through human-to-human contact with infected bodily fluids).

Because Ebola kills almost all its victims quickly and has occurred mostly in remote villages, it has never plagued humans in countries outside Africa. That risk remains small but real given that the disease has spread for the first time to capital cities, all three with airports offering international flights.

This time, Ebola has gotten an edge that has enabled it to infect more people than any preceding outbreak. The epidemic is centered at a crossroads, an area where roads connecting Guinea, Liberia and Sierra Leone come together. It's a place of high mobility, with people coming in and out. People caring for infected relatives often travel considerable distances to do so, then return home, often via minibus, making transmission easier for the virus.

Infected people, lacking understanding of how Ebola is transmitted and fearing the stigma attached to it, have run away or been hidden by their families rather than going to treatment centers. And the bereaved have continued their custom of washing and touching the dead, which can spread the virus.

Although Ebola has menaced Africa since 1976, the outbreaks have until now been in the eastern and central part of the continent. Over time, medical workers in these countries -- Uganda, Republic of the Congo, Democratic Republic of the Congo, Gabon and Sudan -- gained experience managing the disease.

They learned to reach remote communities directly with information about Ebola's transmission, given that many residents don't have access to radio or television; to isolate confirmed cases, trace their contacts and monitor the contacts for symptoms; and to ensure medical workers who care for the ill wear protective suits. Receiving care as soon as symptoms arise reduces the risk of contagion and increases the odds of survival to 30 percent. In the absence of Ebola-specific treatments -- research for which is funded largely by the U.S. government -- care consists of providing fluids, replacing lost blood and treating complications.

Western African countries, however, have had no experience with Ebola. Their governments were slow to acknowledge the severity of the threat and respond accordingly. Sierra Leone even took a step backward by officially counting only cases confirmed by lab tests, which are unavailable in remote areas. This underestimates the disease toll, which can produce a dangerous complacency on the part of local authorities and communities.

Dealing with Ebola patients is not a job for novices, given that one mistake can mean death for the caregiver. Yet even with 300 staff members devoted to the outbreak, Doctors Without Borders is overwhelmed, as is the World Health Organization, which has also dispatched specialists to the region. The solution here is not complicated: Send more people before the disease spreads further.

There is a reservoir of talent elsewhere in Africa -- the doctors, nurses, epidemiologists, lab technicians and administrators in Uganda, Republic of the Congo, Democratic Republic of the Congo and Gabon who have been through this and know how to handle Ebola. By organizing teams of them to help with the current epidemic and pass their skills on to their counterparts in Guinea, Sierra Leone and Liberia, the World Health Organization could establish a pan-African partnership that central and east Africa could, in turn, rely on down the road.

International donors such as the U.S. and the European Union could help fund and provision the African teams. They could enlist the help of international mining companies present in Guinea, which have certainly extracted value from these countries and have both a humanitarian and an economic interest in stability and ending the epidemic.

The governments of the three suffering countries can't be let off the hook. An assessment of Liberia's response to the epidemic identified poor leadership and a lack of coordination among regions as weaknesses. Above all, the governments must be transparent about the extent of the crisis.

Additional transparency is not required to make this clear: This Ebola epidemic is different. Unless resources are mustered to bring it under control, it's going to kill many more people in Africa, and perhaps beyond.

--Editors: Lisa Beyer, Mary Duenwald.

To contact the editor on this story:
David Shipley at davidshipley@bloomberg.net